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December 1, 1989

Hospital Uncompensated Care: Crisis?

JAMA. 1989;262(21):2975-2977. doi:10.1001/jama.1989.03430210013003

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HOSPITAL UNCOMPENSATED care: how much of a crisis? American hospitals are losing money—not all of them; some are doing well. But many are not. Just how much money they are losing and why has become the basis of an accounting debate, a political controversy, and a potential crisis in access to care.

How much care do hospitals provide to those who are uninsured, underinsured, and unable or unwilling to pay? The American Hospital Association (AHA) reports that hospital "unsponsored" care (services for which hospitals are not paid at all, less tax appropriations and subsidies) was $3 billion in 1980 (3.9% of total hospital expenses). In 1987 (the last year for which complete data are available), says AHA Vice President Henry Bachofer, unsponsored care totaled $7.5 billion (4.9% of expenses).

Bachofer views the increase with dismay. He asks "if we are reaching the maximum amount of care that can be subsidized